MD, PhD, MAE, FMedSci, FRSB, FRCP, FRCPEd.

Former chiropractor Malcolm Hooper, 61, and hyperbaric oxygen therapy provider Oxymed Pty Ltd have been fined following the death of a customer in 2016. They were each convicted of three work safety-related charges, all of failing to ensure a workplace is safe and without risks to health. Hooper was fined $176,750, while the company was fined $550,000. Oxymed was trading as HyperMed at its South Yarra premises in April 2016 when a long-term client with multiple sclerosis and a history of life-threatening seizures came in for treatment. He was later found unconscious in a single-person hyperbaric chamber, taken to hospital, and placed on life support, but died five days later.

The County Court heard that both the company and Hooper had an inadequate system in place for assessing the risks oxygen therapy could pose to clients, and an inadequate system too for developing plans to eliminate or reduce those risks. In her judgment, County Court judge Amanda Fox said HyperMed wasn’t a hospital nor a medical practice and had been described as an “alternative health facility”. Hooper had already been deregistered in 2013 by the national board for chiropractors for misleading and deceptive advertising about the benefits of hyperbaric treatment.

Hyperbaric oxygen therapy involves administering pure oxygen in a pressurised environment, with the heightened air pressure allowing a patients’ lungs to gather much more oxygen than would be possible under normal conditions. The therapy is not based on strong data. A systematic review failed to find good evidence for hyperbaric oxygen therapy as a treatment of multiple sclerosis:

Multiple sclerosis (MS) is a chronic, inflammatory, and degenerative neurological illness with no cure. It has been suggested that Hyperbaric Oxygen Therapy (HBO(2)T) may slow or reverse the progress of the disease. This article summarizes the clinical evidence for the use of HBO(2)T in the treatment of MS. We conducted a literature review focused on the interaction of hyperbaric oxygenation and MS. In particular, we appraised the clinical data regarding treatment and performed a meta-analysis of the randomized evidence using the methodology of the Cochrane Collaboration. We found 12 randomized studies in the area, all of which were performed between 1983 and 1987. A meta-analysis of this evidence suggests there is no clinically significant benefit from the administration of HBO(2)T. The great majority of randomized trials investigated a course of 20 treatments at pressures between 1.75ATA and 2.5ATA daily for 60-120 min over 4 weeks against a placebo regimen. None have tested the efficacy of HBO(2)T against alternative current best practice. No plausible benefit of HBO(2)T on the clinical course of MS was identified in this review. It remains possible that HBO(2)T is effective in a subgroup of individuals not clearly identified in the trials to date, but any benefit is unlikely to be of great clinical significance. There is some case for further human trials in selected subgroups and for prolonged courses of HBO(2)T at modest pressures, but the case is not strong. At this time, the routine treatment of MS with HBO(2)T is not recommended.

The case reminds me of that of John Lawler. Mr. Lawlwer’s chiropractor also used a therapy that was not indicated, broke his neck (to put it crudely), and subsequently proved herself more than inept in saving his life. It suggests to me that some chiros may not be trained adequately to deal with emergencies. If that is true, they should perhaps focus less on practice-building courses and more on first aid instructions.

8 Responses to Former chiropractor fined after death of MS patient receiving hyperbaric oxygen therapy

  • Hyperbaric oxygen therapy has been in demand for treating MS for a long time, with very little evidence to support its use. Unfortunately it is the nature of the disease that it remits and relapses, and as people generally seek new treatment when they are at their worst this is usually followed by an improvement more-or-less whatever they do. This makes MS sufferers particularly easy to convince that some dodgy treatment or other has worked, and there are all kinds of campaigns for useless therapies to be made available on the NHS.

    Hyperbaric oxygen therapy has its place in treating other conditions, inlcuding possibly long-term radiation damage. And of course it is standard emergency treatment for decompression sickness in divers.

    I have done a lot of scuba diving myself, and used to do the medicals for my local club. As a result I am well aware of the pharmacological effects that gases can have and how this changes with the inspired pressure. In particular, oxygen can be toxic and high pressures, and above a partial pressure of 1.6 atmospheres it is well-known to trigger epileptic fits, even in individuals without epilepsy. This is equivalent to breathing air at a depth of 70 metres, which no diver would ever do deliberately as they would be unconscious from nitrogen narcosis by then. It is also equivalent to breathing pure oxygen at a depth of 6 metres; normally scuba divers don’t have pure oxygen in their tanks but some very experienced divers using mixed gases sometimes breathe pure oxygen near the surface in order to speed up nitrogen loss from their tissues.

    Anybody operating a hyperbaric oxygen chamber should be well aware of the risk of epileptic fits, and a history of epilepsy would be considered a contraindication to treatment. If there are situations where it might be used, at the very least I would expect there to be a resuscitation team, including an anaesthetist, standing by. Given the circumstances I am surprised that Hooper isn’t facing a manslaughter charge.

    • Likewise – I’m astonished the practitioner isn’t charged with manslaughter or at least the organisation behind the practice isn’t up on a charge of corporate manslaughter. Maybe it’s a US thing.

  • Quote: “Hyperbaric oxygen therapy involves administering pure oxygen in a pressurised environment, with the heightened air pressure allowing a patients’ lungs to gather much more oxygen than would be possible under normal conditions.”

    This gives the impression that the patient is sitting in an environment of pure oxygen. I think that would be fatal very quickly. HOT just increases the percentage of oxygen in the air that they are breathing and increases the air pressure somewhat. Mostly it is pretty benign.

    I wonder if an autopsy was done on the patient to determine actual cause of death. I doubt if it was the HOT. They were fined because the business was operating illegally and this was brought to the attention of the authorities because of the death.

    • Roger,

      This gives the impression that the patient is sitting in an environment of pure oxygen. I think that would be fatal very quickly. HOT just increases the percentage of oxygen in the air that they are breathing and increases the air pressure somewhat. Mostly it is pretty benign.

      Whatever gave you that idea? If you want to increase the percentage of inspired oxygen you just need to use an oxygen cylinder and a mask, and mostly they have a calibrated venturi system to deliver a specific percentage.

      Hyperbaric oxygen is delivered in pressurised chamber, which can vary from some being just large enough for the patient to lie down in others to the size of a room. In Aberdeen there are hyperbaric oxygen chambers large enough to contain an operating theatre in case divers working in the oil industry require emergency surgery. They deliver pure oxygen under pressure. And you are right, it can be fatal very quickly if the operators don’t know what they are doing.

      Sudden death is not a known side-effect of HOT.

      Yes it is.

      Atmospheric gases under pressure have pharmocological effects that are quite different from anything you might expect from simply breathing air. Nitrogen, for instance, becomes an anaesthetic at high enough pressures (possibly as a result of altering the fluidity of nerve cell membranes, though the exact mechanism is unknown). I have experienced this myself.

      Even enriching the oxygen content of inspired air at atmospheric pressure can be dangerous, for instance in the case of individuals with chronic lung disease who retain carbon dioxide and rely on tissue hypoxia to keep themselves breathing (more common than you might think). If you give them oxygen they simply stop breathing and then die from carbon dioxide narcosis. I have seen CO2 narcosis myself many times in hospital when staff have been unaware of this, though happily only one death. It is quite dramatic watching the effect of removing the oxygen mask in these situations. These days it is routine to monitor blood oxygen saturation in anybody being given therapeutic oxygen so this problem is much less common now.

  • Sudden death is not a known side-effect of HOT. It would be interesting to know the Covid vaccine status of the patient. Sudden death IS a known side-effect of these so-called vaccines. Autopsies are not being done on people dying soon after vaccination so I guess were are deliberately being kept in the dark on that.

    • Good old Roger, reliably wrong as always.

    • Absolutely Roger! We are all kept on the dark about vaccine deaths. My friends brother’s wife’s cousin’s daughter’s boyfriend died suddenly after falling off a cliff. Autopsy was not performed even after his family requested one. What are they hiding? He was fully vaccinated. Was he being controlled via 5G thru the microchip implanted during vaccination? An autopsy would reveal this and I think that is what they are hiding. Microchip in every vaccinated person, imagine the power of the person who is able to control a large percentage of world population with a few mouse clicks. Every death regardless of the cause should be treated with suspicion and bodies autopsied. Public should demand autopsies!!

    • @Roger

      I guess were are deliberately being kept in the dark on that.

      No need for that, as you’re already doing an absolutely sterling job keeping yourself in the dark.

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